Healthcare Provider Details

I. General information

NPI: 1093855140
Provider Name (Legal Business Name): BERRY & LOBEL, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 08/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 QUINCY ST
BROCKTON MA
02302-2926
US

IV. Provider business mailing address

209 QUINCY ST
BROCKTON MA
02302-2926
US

V. Phone/Fax

Practice location:
  • Phone: 508-584-2291
  • Fax: 508-584-3480
Mailing address:
  • Phone: 508-584-2291
  • Fax: 508-584-3480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6229
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number105991
License Number StateMA

VIII. Authorized Official

Name: DR. STEPHEN CHARLES BONSIGNORE-BERRY
Title or Position: CLINICAL PSYCHOLOGIST CO-OWNER
Credential: PSY.D.
Phone: 508-584-2291